ПИЛОТНАЯ ВЕРСИЯ ШКАЛЫ СЛОЖНОСТИ ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПРИ НЕЙРОГЕННЫХ ОПУХОЛЯХ АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ У ДЕТЕЙ

Abstract

The purpose of this research was to develop a scale for risk, difficulty and complexity assessment of laparoscopic surgical interventions for neurogenic tumors of abdominal localization in children taking into account IDRF, tumor size and other criteria that affect the surgical outcome. Materials and methods used: 124 patients (68 (55%) boys/56 (45%) girls) aged 0 to 18 y/o (median age of 20.5 [5-50.5] months old) who have undergone laparoscopic surgery for neurogenic tumors of abdominal localization in Jan. 2018-Apr. 2022 were included in a single-center retrospective cohort study. An analysis was made of the relationship between the 24 criteria for the complexity of the surgical intervention and the parametric evaluation of its results (duration of surgical intervention; intraoperative blood loss; intraoperative blood transfusion; intraoperative complications and access conversion). As for the quantitative variables, the Spearman's rank correlation coefficient was used, and the eta coefficient for qualitative variables. Cluster analysis was used to distribute points by the difficulty levels. The ROC curve analysis with sensitivity and specificity for high level of complexity was used to check the scale of complexity. Results: median duration of surgical intervention was 105 [75; 150] min, volume of intraoperative blood loss - 5 [5; 20] ml. Blood transfusion was required in 15 (12%) cases, median blood transfusion was 0 [0; 0] ml. Intraoperative complications developed in 4 (3%) cases. Conversions were performed in 4 (3%) patients. 10 complexity criteria were selected: IDRF F1, F2, F3, F4, F5, location of the tumor center, extension beyond the midline, previous open surgery, contact of the tumor with the inferior vena cava, and the tumor volume (ml)/height (m) ratio of > or </= 28. A pilot difficulty scale with three levels of difficulty has been developed. Sensitivity for a high level of complexity (6 or over pts) was 60% (95% CI 23.1-88.2%), specificity was 98.3% (95% CI 94.1-99.5%). Conclusion: different IDRFs contribute differently to the complexity and risk of laparoscopic surgery. The ratio of tumor size to growth is more significant criterion of complexity than the absolute size of the neoplasm. Other criteria of complexity also play an important role, such as previous open surgeries and tumor localization, in particular. The Authors do not recommend this scale for clinical use because the results obtained in this research would form the basis for further prospective study aiming to the development of a more accurate scale of the complexity of laparoscopic operations in neurogenic tumors of the abdominal localization.